The risk of exposure to blood and blood-borne pathogens is slightly greater for health care personnel than for people who do not work around blood. An exposure to infected blood, tissue, or other potentially infectious body fluids can occur by: Percutaneous injury (e.g. a needle-stick or cut with a sharp object) OR Contact with mucous membrane or non-intact skin (e.g. skin that is chapped, abraded, or affected by dermatitis).

After percutaneous injury, the risk of infection varies for specific bloodborne pathogens: a. Hepatitis B virus (HBV): If the source patient is Hepatitis B surface antigen (HBsAg)-positive AND Hepatitis B e antigen (HBeAg)-positive, the risk of Hepatitis B transmission is approximately 37%-62%. If the source patient is HBsAg-positive and HBeAg-negative, the risk of Hepatitis B transmission is approximately 23%- 37%. b. If the source patient has Hepatitis C (HCV), the risk of Hepatitis C transmission is approximately 1.8% (range 0%-7%).): c. If the source patient has HIV infection, the risk of HIV transmission is approximately 0.3% after a percutaneous exposure, and 0.09% after a mucous membrane exposure. The risk of infection appears to be higher with: - Exposure to a larger quantity of blood or other infectious fluid. - Prolonged or extensive exposure of non-intact skin or mucous membrane to blood or other infectious fluid or concentrated virus in a laboratory setting. - Exposure to the blood of a patient in an advanced disease stage or with a high viral load. - A deep percutaneous injury. - An injury with a hollow-bore, blood-filled needle.

  • Step 1: Treat Exposure Site
  • Step 2: Report and document
  • Step 3: Refer to special care to explore the exposure and the source of exposure, and to register
  • Step 4: Get Baseline testing for ALL exposures.
  • Step 5: Start PEP if indicated Step 6: Follow up visits

Airborne transmission occurs through very small particles or droplet nuclei that contain infectious agents and can remain suspended in air for extended periods of time. When they are inhaled by a susceptible individual, they enter the respiratory tract and can cause infection. Since air currents can disperse these particles or droplet nuclei over long distances, airborne transmission does not require face-to-face contact with an infected individual. Airborne transmission only occurs with infectious agents that are capable of surviving and retaining infectivity for relatively long periods of time in airborne particles or droplet nuclei. Only a limited number of diseases are transmissible via the airborne route (TB, measles, flu, whooping cough) If you have been around someone who has TB disease, you should go to your doctor or your local health department for tests. There are two tests that can be used to help detect TB infection: a TB skin test or a TB blood test. Isoniazid preventive therapy might be administered, after the specialist evaluates.

Human coronaviruses are common throughout the world. The name corona refers to a crown because these viruses have crown-like spikes on their surface when viewed under an electron microscope. There are many different coronaviruses identified in animals but only a small number of these can cause disease in humans. Some coronaviruses such as 229E, NL63, OC43 and HKU1 are common causes of illness, including respiratory illness, in humans throughout the world. Sometimes coronaviruses infecting animals can evolve to cause disease in humans and become a new (novel) coronavirus for humans. Examples of this are the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), first reported from Saudi Arabia in 2012, and the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), first recognized in China in 2002. 

On 7 January 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed as the causative agent of coronavirus disease 2019 (COVID-19). The majority of the case-patients initially identified were dealers and vendors at a seafood, poultry and live wildlife market (Huanan Seafood Wholesale Market) in Jianghan District of Hubei Province. This suggests that the novel coronavirus has a possible zoonotic origin. The specific source of the virus is not yet known.

As there is community transmission of SARS-CoV-2 in South Africa, all South Africans are at risk of infection with SARS-CoV-2 (illness called COVID-19). There are areas of the country where local transmission of the virus may be occurring at higher rates than other areas. Daily updates are available on www.nicd.ac.za and www.health.gov.za. 

People who have been in contact with a confirmed case of COVID-19 are at an increased risk of infection and disease.  In addition, healthcare workers have an increased risk of acquiring infection in the workplace. The elderly and individuals with co-morbidities, such as heart disease (including high blood pressure), chronic respiratory diseases, cancer patients, endocrine diseases (such as diabetes), have been found to be at a higher risk of severe illness and mortality associated with COVID-19. 

Transmission of the virus is via respiratory droplets, similar to how influenza and other respiratory pathogens spread. When a person infected with COVID-19 coughs or sneezes, they release droplets of infected fluid. Larger droplets fall on nearby surfaces for example tables, counters in shops, seats in cars/taxi etc. If you touch these surfaces the virus may transfer to your hands, then to mouth, nose or eyes when you touch your face.  People may also be infected by breathing in droplets if standing with 1m of infected person.  You cannot become infected through your skin. 

The following categories of people should be tested in both the public and private health sectors

  1. Hospitalised patients
    • Symptomatic patients must be prioritised, and test results should be received within 24 hrs
    • All other patients should be tested on admission
  2. Any person with symptoms where COVID-19 infection is considered to be a possible cause
    • Persons at high-risk for infection or poor outcomes, eg. health care workers, those older than 60 years, those with comorbidities, pregnant women, should be prioritised. 
  3. Individuals who are close contacts of confirmed cases, including asymptomatic contacts. Whilst a close contact is generally defined as contact with one metre of a COVID-19 confirmed cases for more than 15 minutes without PPE (no face cover/eye cover), alternative definitions should be used in some high-risk settings (eg: clusters/outbreaks).
  4. Post-mortem testing should be conducted in line with current guidelines 
  5. The following individuals or groups should not be tested (unless they fall into one of the priority groups):
    • Asymptomatic people including employees/learners for purposes of returning to work/schoo
    • Selected groups eg. sportspersons
    • Patients meeting de-isolation criteria as per National Department of Health clinical guidelines should not be tested

Read the updated prioritised COVID-19 testing Guidelines here

COVID-19 is diagnosed by a laboratory test, polymerase chain reaction (PCR) molecular test, on a respiratory tract sample (e.g. sample from nose, throat or chest). This test detects the SARS-CoV-2 genetic material.

Symptoms include ANY of the following respiratory symptoms: cough, sore throat, shortness of breath, anosmia (loss of sense of smell), dysgeusia (alteration of the sense of taste) with or without other symptoms (which may include fever, weakness, myalgia, or diarrhoea)

The severity of illness can range from people who are infected without any illness (asymptomatic infection) to mild respiratory illness, to severe illness requiring admission to hospital or death. The majority of patients (approximately 80%) will have mild respiratory illness.

If you test positive for COVID-19 and your symptoms are mild, you need to isolate at home and if possible, in a separate room away from your loved ones. If your condition worsens, please seek medical help as soon as possible. 

READ GUIDELINES ON WHAT TO DO NEXT IF YOU TESTED POSITIVE

READ GUIDELINES ON HOW TO SAFELY ISOLATE  HERE

Please keep in contact with your health care provider telephonically to monitor your progress. 

Treatment is supportive (e.g. provide oxygen for patients with shortness of breath or treatment for fever). Antibiotics do not treat viral infections. However, antibiotics may be required if a bacterial secondary infection develops. There are several studies in progress using different medications that may have some effectiveness against the virus. Remdesivir is a repurposed antiviral drug. Data are conflicting as to the clinical benefits of this agent and more data are awaited.

COVID-19 CLINICAL TREATMENT GUIDELINES  AVAILABLE HERE

Currently there is no vaccine for COVID-19. There are no specific measures currently recommended to prevent COVID-19 but the following can provide protection against infection with coronaviruses and many other viruses that are more common in South Africa:

  • Practice physical distancing, this means keeping a physical distance of at least 2 metres from all people you interact with, specifically when out in public. This keeps you safe from respiratory droplets.
  • Practice social distancing, this means not interacting with people outside of your household unless necessary.
  • The use of a cloth mask (not medical mask as these are need for health care workers) may help protect you and people around you. Please look at the recommendation for these masks.
  • Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer (at least 70% alcohol).
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Cover your cough or sneeze with a flexed elbow or a tissue, then throw the tissue in the bin.
  • Avoid close contact with people who are sick.
  • Stay at home when you are sick and try and keep distance from others at home.
  • Clean and disinfect frequently touched objects and surfaces.

A close contact is defined as a person having had face-to-face contact (less than 1 metre) or having been in a closed space with a confirmed COVID-19 case for at least 15 minutes. This includes, amongst others:

  • All persons living in the same household as a COVID-19 case, and people working closely in the same environment as a case.
  • Healthcare workers or other people providing direct care for a COVID-19 case while not
  • wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, N95 respirator, eye protection).
  • A contact in an aircraft sitting within two seats (in any direction) of the case, travel
  • companions or persons providing care, and crew members serving in the section of the aircraft where the case was seated.

It is important to note that there is a difference between being fully recovered and being ready to come out of isolation.

The following criteria are specified for de-isolation of a person who tests positive for COVID-19:

  • Symptomatic patients with mild disease (not requiring hospitalisation for Covid-19) can be de-isolated 10 days after the onset of their symptoms, provided their fever has resolved and their other symptoms are improving.
  • Hospitalised patients with moderate-severe disease (who require hospitalisation due to COVID-19) can be de-isolated 10 days after achievement of clinical stability (i.e. from when they are not requiring supplemental oxygen and are otherwise clinically stable).
  • Asymptomatic patients can be de-isolated 10 days after their test.
  • Repeat PCR testing is NOT required in order to de-isolate a patient and is not recommended.

It is common for patients to continue to have symptoms for longer than the above time periods. Full recovery may take several weeks for some patients, especially for symptoms such as fatigue, cough and anosmia (loss of sense of smell). Patients who are still symptomatic at the end of their isolation period can be de-isolated provided that their fever has resolved and their other symptoms have shown improvement. Patients admitted to hospital can continue their isolation period at home or at an isolation facility once clinical stability has been achieved.

Employees can return to work:

  1.  10 days after symptom onset for cases of mild disease
  2. 10 days after clinical stability (e.g. after oxygen stopped) for cases of severe disease

Note: PCR testing is not required for return to work (exception: if a person remains asymptomatic in quarantine after a high-risk exposure to a confirmed COVID-19 case, a PCR test should be done when assessing the employee for early return to work on day 8 post-exposure).  

Distinction between isolation period and returning to work

The recommended isolation time is the period during which a patient is still considered infectious. This should be distinguished from the point at which a patient is medically well enough to return to work. Some patients, especially those who have had severe disease, may require to be booked off sick for longer than the above isolation periods.

The main test used to diagnose COVID-19 is a polymerase chain reaction (PCR) test, which detects the genetic material (RNA) of SARS-CoV-2, the virus which causes COVID-19.

If you test positive then it means that genetic material of the virus was detected in your sample, which is normally a sample collected from your nose or throat and confirms a diagnosis of SARS-CoV-2 infection. A negative test does not exclude an infection with SARS-CoV-2, as your test result depends on when your sample was collected and the quality of the sample that was collected. 

The amount of virus in your body (called the viral load) changes during the course of an infection, starting from low levels which increase over a few days and then start to decrease towards the later stages of infection. How long you have the virus for (called viral shedding) depends on many factors such as your age, whether you have an underlying condition and how severe your disease is. Viral shedding is generally detectable around 2-3 days before the onset of symptoms and tends to decrease after about 7 days from the onset of symptoms.

Although the PCR test is a very sensitive test, there is no test that is 100% sensitive and so if you are tested very early in your infection, and the viral loads in your body are low then the test may not detect the virus. However, if tested later in infection, when viral loads are higher, your test may change to positive. Similarly, if you are tested towards the end of the infection, your test result may change to negative.

The test result is also affected by the type and quality of the sample that is collected. If a poorly collected sample is tested, then it is possible that not enough clinical material was collected from you and your test result will be negative when you are infected. If your clinician suspects a false-negative result, they will request that a repeat sample is collected to be re-tested.

If your COVID-19 test result changes on repeat samples, it does not mean that a laboratory error was made but could reflect that the viral load has gone down or could be due to poor sample collection.

HIV can be spread in the following ways:

  1. Unprotected sex — sex without a condom — withan infected partner/s.
  2. Drug injection by the sharing of HIV-contaminated needles and syringes;
  3. Transfusion of blood or blood products contaminated with HIV;
  4. From an HIV-infected woman to her baby – during pregnancy at the time of birth, or during breastfeeding

The risk of exposure to blood and blood-borne pathogens is slightly greater for health care personnel than for people who do not work around blood. The HIV exposure types are percutaneous, that can be classified as Less severe (Solid needle, superficial injury) and More Severe (Large-bore, hollow needle, Deep puncture, Visible blood on device, Needle used in artery or vein). Next is mucous membrane and nonintact skin: Small Volume (A few drops) and Large Volume (Large blood splash). If the source patient has HIV infection, the risk of HIV transmission is approximately 0.3% after a percutaneous exposure, and 0.09% after a mucous membrane exposure. The risk of infection appears to be higher with: - Exposure to a larger quantity of blood or other infectious fluid. - Prolonged or extensive exposure of non-intact skin or mucous membrane to blood or other infectious fluid or concentrated virus in a laboratory setting. - Exposure to the blood of a patient in an advanced disease stage or with a high viral load. - A deep percutaneous injury. - An injury with a hollow-bore, blood-filled needle.

The only way to know for sure whether you have HIV is to get tested. Knowing your HIV status gives you powerful information to help you take steps to keep you and your partner healthy. If you test positive, you can take medicine to treat HIV to stay healthy for many years and greatly reduce the chance of transmitting HIV to your sex partner. If you test negative, you have more tools available today to prevent HIV than ever before.

It can take some time for the immune system to produce enough antibodies for the HIV test to detect. This time period can vary from person to person. Most people will develop detectable antibodies within two to eight weeks (the average is 20 days to 25 days) of exposure. Even so, there is a chance that some people will take longer to develop detectable antibodies. If the initial negative HIV test was conducted within the first three months after possible exposure, repeat testing should be done at six months.

Most HIV tests use a blood sample, either from a blood draw or a finger prick, but some use oral fluid or urine. Tests that use blood are even more accurate than other tests. Test results can be ready within as little as 20 minutes to a few days, depending on the type of test. HIV tests are very accurate at detecting HIV, but no HIV test can detect HIV immediately after infection. How soon a test can detect infection depends upon different factors, including the type of test being used. In general, nucleic acid tests (NAT) can detect HIV the soonest, followed by combination or fourth generation tests, and then antibody tests. Most HIV tests, including most rapid tests and home tests, are antibody tests. Antibodies are produced by your immune system when you’re exposed to viruses like HIV and bacteria. Antibody tests look for these antibodies to HIV in your blood or oral fluid. In general, antibody tests that use blood can detect HIV slightly sooner after infection than tests done with oral fluid. If you use any type of antibody test and have a positive result, you will need to take a follow-up test to confirm your results. If your first test is a rapid home test and it’s positive, you will be sent to a health care provider to get follow-up testing. If your first test is done in a testing lab and it’s positive, the lab will conduct the follow-up testing, usually on the same blood sample as the first test.

The window period varies from person to person, and is also different depending upon the type of HIV test. Most HIV tests are antibody tests. It takes time for the body to produce enough antibodies for an HIV test to show that a person has HIV. The soonest an antibody test will detect infection is 3 weeks. Most, but not all people will develop detectable antibodies within 3 to 12 weeks of infection.

A positive result means: -

  • You are HIV-positive (carrying the virus that causes AIDS).
  • You can infect others and should try to implement precautions to prevent doing so.

A negative result means:

  • No antibodies were found in your blood at this time.

A negative result does NOT mean: -

  • You are not infected with HIV (if you are still in the window period).
  • You are immune to AIDS.
  • You have a resistance to infection.
  • You will never get AIDS.

Testing positive for HIV means that you now carry the virus that causes AIDS. It does not mean that you have AIDS, nor does it mean that you will die. Although there is no cure for AIDS, many opportunistic infections that make people sick can be controlled, prevented or eliminated. This has substantially increased the longevity and quality of life for people living with AIDS.

Step 1: Treat Exposure Site Step 2: Report and document Step 3: Refer to special care to explore the exposure and explore the source of exposure Step 4: Baseline testing for ALL exposures. Step 5: Immediately start PEP-24-36 hours: A basic 2-drug regimen, appropriate for lower risk exposures and an expanded 3-drug regimen, for exposures that pose an increased risk for transmission.If information on the source is unknown, and the decision to start PEP is made (based on risk factors, exposure type, etc.), PEP should not be delayed; changes can be made as needed after PEP has been started. If source patient is found to be HIV-negative, PEP should be discontinued. The choice of PEP depends on exposure and also on the source person HIV status and class. Step 6: Baseline CBC, creatinine, and liver enzyme tests (AST, ALT, alkaline phosphatase, total bilirubin) should be obtained. Step 7: Get reevaluated within 72 hours as additional information about the source is obtained. Step 8: HIV exposure follow-up testing: - Repeat HIV-antibody testing at 6 weeks, 3 months, and 6 months post exposure. - If illness compatible with acute retroviral syndrome occurs, perform HIV viral load. - Extended follow-up (12 months) is recommended for HCP who become infected with HCV following an exposure to a source co-infected with HIV and HCV. Step 9: Receive post-exposure counselling:refrain from donating blood, plasma, organs, tissue, or semen; to avoid breastfeeding; use methods to prevent pregnancy; and to use risk reduction methods including latex barriers during sex, not sharing injection equipment, and abstaining from risk behaviors.

Yes. PEP is initiated within 24-36 hours of exposure: A basic 2-drug regimen, appropriate for lower risk exposures and an expanded 3-drug regimen, for exposures that pose an increased risk for transmission. If information on the source is unknown, and the decision to start PEP is made (based on risk factors, exposure type, etc.), PEP should not be delayed; changes can be made as needed after PEP has been started. If source patient is found to be HIV-negative, PEP should be discontinued. The choice of PEP depends on exposure and also on the source person HIV status and class.

HBV is transmitted through activities that involve percutaneous (i.e., puncture through the skin) or mucosal contact with infectious blood or body fluids (e.g., semen, saliva), including Hepatitis B virus (HBV) is transmitted through exposure to infective blood, semen, and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood. Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. HBV also poses a risk to healthcare workers who sustain accidental needle stick injuries while caring for infected-HBV patients. A safe and effective vaccine is available to prevent HBV. HBV is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing.

Hepatitis B is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness. It results from infection with the Hepatitis B virus. Hepatitis B can be either “acute” or “chronic.” Acute Hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis B virus. Acute infection can — but does not always — lead to chronic infection. Chronic Hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in a person’s body.

The presence of signs and symptoms varies by age. Most children under age 5 years and newly infected immunosuppressed adults are asymptomatic, whereas 30%–50% of persons aged ≥5 years have initial signs and symptoms. When present, signs and symptoms can include: Fever, Fatigue, Loss of appetite, Nausea, Vomiting, Abdominal pain, Dark urine, Clay-colored bowel movements, Joint pain, Jaundice. Persons with chronic HBV infection might be asymptomatic, have no evidence of liver disease, or have a spectrum of disease ranging from chronic hepatitis to cirrhosis or hepatocellular carcinoma (a type of liver cancer).

Symptoms begin an average of 90 days (range: 60–150 days) after exposure to HBV.

Yes. The Hepatitis B vaccine is safe and effective and is usually given as 3-4 shots over a 6-month period./expand]

The Hepatitis B vaccine series is a sequence of shots that stimulate a person’s natural immune system to protect against HBV. After the vaccine is given, the body makes antibodies that protect a person against the virus. An antibody is a substance found in the blood that is produced in response to a virus invading the body. These antibodies are then stored in the body and will fight off the infection if a person is exposed to the Hepatitis B virus in the future.

The Advisory Committee on Immunization Practices recommends that Health care and public safety workers at risk for exposure to blood or blood-contaminated body fluids be vaccinated against hepatitis B.

Yes, it is recommended in the following settings: a. In certain health care, evaluation, or treatment settings, a high proportion of clients have known risk factors for HBV infection. b. Sexually transmitted disease treatment facilities c. HIV testing and treatment facilities d. Facilities providing drug-abuse treatment and prevention services e. Health care settings targeting services to injection drug users f. Correctional facilities g. Health care settings targeting services to men who have sex with men h. Chronic hemodialysis facilities and end-stage renal disease programs i. Institutions and nonresidential day care facilities for developmentally disabled persons

After a person has been exposed to HBV, appropriate prophylaxis, given as soon as possible but preferably within 24 hours, can effectively prevent infection. The mainstay of postexposure immunoprophylaxis is hepatitis B vaccine, but in certain circumstances, the addition of HBIG will provide increased protection.

If you are concerned that you might have been exposed to the Hepatitis B virus, call your health professional or your health department. If a person who has been exposed to Hepatitis B virus gets the Hepatitis B vaccine and/or a shot called “HBIG” (Hepatitis B immune globulin) within 24 hours, Hepatitis B infection may be prevented.

There are many different blood tests available to diagnose Hepatitis B. They can be ordered as an individual test or as a series of tests. Ask your health professional to explain what he or she hopes to learn from the tests and when you will get the results. Below are some of the common tests and their meanings. But remember: only your doctor can interpret your individual test results.

Antiviral agents active against HBV exist. Treatment of HBV infection has been shown to reduce the risk of liver cancer and death. It is estimated that 20–30% of persons with HBV infection could benefit from treatment. However, drugs active against HBV are not widely available or utilized in persons infected with HBV. Currently recommended antiviral agents used for treatment of human immunodeficiency virus (HIV) infection do not adequately suppress HBV, which is of great concern for the estimated 10% of the HIV-infected persons in Africa who are co-infected with HBV.

The HBV exposure types are percutaneous, that can be classified as Less severe (Solid needle, superficial injury) and More Severe (Large-bore, hollow needle, Deep puncture, Visible blood on device, Needle used in artery or vein). Next is mucous membrane and nonintact skin: Small Volume (A few drops) and Large Volume (Large blood splash). If the source patient is Hepatitis B surface antigen (HBsAg)-positive AND Hepatitis B e antigen (HBeAg)-positive, the risk of Hepatitis B transmission is approximately 37%-62%. If the source patient is HBsAg-positive and HBeAg-negative, the risk of Hepatitis B transmission is approximately 23%- 37%. The risk of infection appears to be higher with: - Exposure to a larger quantity of blood or other infectious fluid. - Prolonged or extensive exposure of non-intact skin or mucous membrane to blood or other infectious fluid or concentrated virus in a laboratory setting. - Exposure to the blood of a patient in an advanced disease stage or with a high viral load. - A deep percutaneous injury. - An injury with a hollow-bore, blood-filled needle.

  • Step 1: Treat Exposure Site
  • Step 2: Report and document
  • Step 3: Refer to special care to explore the exposure and the source of exposure
  • Step 4: Baseline testing for ALL exposures.
  • Step 5: HBV PEP should be initiated IMMEDIATELY (preferably within 24 hours but within 7 days). It depends on exposed vaccination status and source HBsAg status.
  • Step 6:HBV exposure follow-up testing and counseling: Test for anti-HBs 1-2 months after last dose of vaccine; Anti-HBs cannot be ascertained if HBIG given within 6-8 weeks.
  • Step 7: Receive post-exposure counselling: refrain from donating blood, plasma, organs, tissue, or semen; to avoid breastfeeding; use methods to prevent pregnancy; and to use risk reduction methods including latex barriers during sex, not sharing injection equipment, and abstaining from risk behaviours.

Yes: it depends on the vaccination status of exposed person and the status of the source. The PEP consists of HBV vaccination if the exposed health care worker is unvaccinated and if the source HBsAg is positive, it includes also HBIG. If the exposed health care worker is vaccinated, then it maybe requires no treatment or HBIG, depending on vaccination reaction and source status.

Any blood spills — including dried blood, which can still be infectious — should be cleaned using 1:10 dilution of one-part household bleach to 10 parts of water for disinfecting the area. Gloves should be used when cleaning up any blood spills.

Hepatitis C is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver. It results from infection with the Hepatitis C virus (HCV), which is spread primarily through contact with the blood of an infected person. Hepatitis C can be either “acute” or “chronic.” Acute Hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis C virus. For most people, acute infection leads to chronic infection. Chronic Hepatitis C virus infection is a long-term illness that occurs when the Hepatitis C virus remains in a person’s body. Hepatitis C virus infection can last a lifetime and lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer.

Hepatitis C virus (HCV) is mostly also transmitted through exposure to infective blood. This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Sexual transmission is also possible, but is much less common. There is no vaccine for HCV. Hepatitis C virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing. It is also not spread through food or water.

HCV is generally considered to be a curable disease but for many persons this is not a reality. Scientific advances and intense research and development have led to the development of many new oral antiviral drugs for HCV infection. A great number of HCV specific oral drugs are in the late stage of development; some have been recently registered. These are more effective and better tolerated. Much still needs to be done to ensure that these new treatment advances lead to greater access and treatment responses in resource constrained areas of the world./expand]

Approximately 15%–25% of persons clear the virus from their bodies without treatment and do not develop chronic infection; the reasons for this are not well known

HCV infection becomes chronic in approximately 75%–85% of cases.

The presence of signs and symptoms varies by age. Most children under age 5 years and newly infected immunosuppressed adults are asymptomatic, whereas 30%–50% of persons aged ≥5 years have initial signs and symptoms. When present, signs and symptoms can include: Fever, Fatigue, Loss of appetite, Nausea, Vomiting, Abdominal pain, Dark urine, Clay-colored bowel movements, Joint pain, Jaundice. Persons with chronic HCV infection might be asymptomatic, have no evidence of liver disease, or have a spectrum of disease ranging from chronic hepatitis to cirrhosis or hepatocellular carcinoma (a type of liver cancer).

Several blood tests are performed to test for HCV infection, including: a. Screening tests for antibody to HCV (anti-HCV) b. enzyme immunoassay (EIA) c. enhanced chemiluminescence immunoassay (CIA) d. Qualitative tests to detect presence or absence of virus (HCV RNA polymerase chain reaction [PCR]) e. Quantitative tests to detect amount (titer) of virus (HCV RNA PCR)

HCV infection can be detected by anti-HCV screening tests (enzyme immunoassay) 4–10 weeks after infection. Anti-HCV can be detected in >97% of persons by 6 months after exposure.

HCV RNA appears in blood and can be detected as early as 2–3 weeks after infection.

Not yet. Vaccines are available only for Hepatitis A and Hepatitis B. Research into the development of a vaccine is under way.

The HBV exposure types are percutaneous, that can be classified as Less severe (Solid needle, superficial injury) and More Severe (Large-bore, hollow needle, Deep puncture, Visible blood on device, Needle used in artery or vein). Next is mucous membrane and nonintact skin: Small Volume (A few drops) and Large Volume (Large blood splash). If the source patient has Hepatitis C (HCV), the risk of Hepatitis C transmission is approximately 1.8% (range 0%-7%). The risk of infection appears to be higher with: - Exposure to a larger quantity of blood or other infectious fluid. - Prolonged or extensive exposure of non-intact skin or mucous membrane to blood or other infectious fluid or concentrated virus in a laboratory setting. - Exposure to the blood of a patient in an advanced disease stage or with a high viral load. - A deep percutaneous injury - An injury with a hollow-bore, blood-filled needle

Step 1: Treat Exposure Site Step 2: Report and document Step 3: Refer to special care to explore the exposure and the source of exposure Step 4: Baseline testing for ALL exposures. Step 5: HCV exposure follow-up testing and counseling: Repeat test for anti-HCV and ALT at least 4-6 months post exposure; confirm repeatedly positive anti-HCV EIA results with supplemental tests. Test for HCV RNA at 4-6 weeks for earlier diagnosis. During follow-up period, refrain from donating blood, plasma, organs, tissue, or semen./expand]

No. At this point, there are no recommendations for HCV PEP. Immuneglobulin is not effective. Exposed HCP should receive appropriate counseling, testing, and follow up. (See HIV Exposures section below.)For seroconverters, pegylated interferon may be effective if started soon after HCV seroconversion.

Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs. But TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal.

TB is spread through the air from one person to another. The bacteria are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected. However, not everyone infected with TB bacteria becomes sick. People who are infected, but not sick, have what is called latent TB infection. People who have latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB to others. But some people with latent TB infection go on to get TB disease. People with TB disease can be treated if they seek medical help. Even better, most people with latent TB infection can take medicine so that they will not develop TB disease.

You may have been exposed to TB if you spent time near someone with TB disease of the lungs or throat. You can only get infected by breathing in TB germs that a person coughs into the air. You cannot get TB from someone’s clothes, drinking glass, eating utensils, handshake, toilet, or other surfaces where a TB patient has been.

In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body and can become active later. This is called latent TB infection. People with latent TB infection: a. Have no symptoms b. Don’t feel sick c. Can’t spread TB bacteria to others d. Usually have a positive skin test reaction or positive TB blood test e. May develop TB disease if they do not receive treatment for latent TB infection Many people who have latent TB infection never develop TB disease. In these people, the TB bacteria remain inactive for a lifetime without causing disease. But in other people, especially people who have weak immune systems, the bacteria become active, multiply, and cause TB disease.

If the immune system can’t stop TB bacteria from growing, the bacteria begin to multiply in the body and cause TB disease. The bacteria attack the body and destroy tissue. If this occurs in the lungs, the bacteria can actually create a hole in the lung. Some people develop TB disease soon after becoming infected (within weeks) before their immune system can fight the TB bacteria. Other people may get sick years later, when their immune system becomes weak for another reason.

Symptoms of TB disease depend on where in the body the TB bacteria are growing. TB disease in the lungs may cause symptoms such as: a. A bad cough that lasts 3 weeks or longer b. Pain in the chest c. Coughing up blood or sputum (phlegm from deep inside the lungs) Other symptoms of TB disease are: – Weakness or fatigue – Weight loss – No appetite – Chills – Fever – Sweating at night

If you have been around someone who has TB disease, you should go to your doctor or your local health department for tests. There are two tests that can be used to help detect TB infection: a TB skin test or a TB blood test. Isoniazid preventive therapy might be administered, after the specialist evaluates.

The TB skin test: The TB skin test may be used to find out if you are infected with TB bacteria. You can get a skin test at the health department or at your doctor’s office. A health care worker will inject a small amount of testing fluid (called tuberculin or PPD) into the skin on the lower part of your arm. After 2 or 3 days, you must return to have your skin test read by the health care worker. You may have swelling where the tuberculin was injected. The health care worker will measure this swelling and tell you if your reaction to the test is positive or negative. A positive reaction usually means that you have been infected by someone with TB disease. TB blood tests: TB blood tests use a blood sample to find out if you are infected with TB bacteria. The tests measure the response of TB proteins when they are mixed with a small amount of blood. Examples of these TB blood tests include QuantiFERON®-TB Gold in-Tube test (QFT-GIT) and T-Spot® .TB test.

If you have a positive reaction to the TB skin test or TB blood test, your doctor or nurse may do other tests to see if you have TB disease. These tests usually include a chest x-ray. They may also include a test of the sputum you cough up. Because the TB bacteria may be found somewhere other than your lungs, your doctor or nurse may check your urine, take tissue samples, or do other tests. If you have TB disease, you will need to take medicine to treat the disease.

It can almost always be treated and cured with medicine. But the medicine must be taken as directed by your doctor or nurse. If you have TB disease, you will need to take several different medicines. This is because there are many bacteria to be killed. Taking several medicines will do a better job of killing all of the bacteria and preventing them from becoming resistant to the medicines.